HPV (Human Papilloma Virus)

There are more than 60 viral strains lumped together under the term Human Papilloma Virus (HPV). These viruses can cause warts anywhere on the human body. The HPV types that attack the genital tract are sexually transmitted; HPV is currently the most common sexually transmitted virus in the United States with a 1000% increase in HPV patients since 1987.

Because it is a non-reportable disease, the actual number of patients infected with HPV is unknown. It is believed more than 50 million Americans are currently infected with the virus, with the number growing by a million every year.

Venereal warts (also known as genital warts or condylomata) are the “clinical” form of this infection because they can be easily seen and diagnosed. Venereal warts look like a fleshy bump of tissue on the labia, clitoris, or around the anus. The “sub-clinical” version is more common, and resides under the skin and cannot be seen. The sub-clinical varieties have been linked to cancers of the genital tract so it is important for sexually active women to have yearly Pap tests to detect pre-cancerous changes. You are at risk for HPV if you have had sex with more than one partner, or have had sex with a person who has had more than one partner.

Whether there are symptoms depends on the strain of HPV present. If there are warts, you will notice a raised, fleshy area. If left untreated, the wart may disappear or it may grow and merge with other warts to take on a cauliflower-like appearance. Some people complain of burning or itching and occasionally a wart may bleed if irritated. You may see warts appear from one to eight months after exposure, or they may appear many months or years later. It may be difficult or impossible for you to determine when you were exposed.

Evidence of a sub-clinical infection may first show up on a Pap test. Your test may show HPV changes or dysplasia (pre-cancerous cells). HPV infection on the cervix usually has no symptoms at all.

Diagnosis

HPV cannot be grown in a lab and there is no blood test for it. Diagnosis of warts is usually made visually. If a suspected wart is flat and difficult to see, your doctor may look at the area with a Colposcope (a binocular-like instrument). Warts or HPV infection on the cervix is suggested on a Pap test. Definitive diagnosis is usually made with a colposcopic exam and biopsies.

There is a test available that can identify HPV DNA called the Virapap. This test will only indicate whether you are shedding the HPV virus when the test is performed; a negative result does not necessarily mean you have not come into contact with the virus. If your doctor is going to request the HPV test, the cells collected for a Pap smear will be used for the test.

By testing for the presence of the virus, the early detection of cervical disease is improved with the consequent saving of lives. Early detection of HPV is an important part of cervical cancer prevention. Apart from HPV testing, borderline Pap smears can be more accurately evaluated with PAPNET, an FDA approved computer assisted test which helps the pathologist more accurately interpret the Pap smear slide.

Once you have the virus it will always be present in your body, but it can be controlled. Visible warts can be treated as they appear so you may have to return to your doctor for repeat treatments. It is important to note, however, that the majority of HPV infections go away on their own and do not cause any abnormal growths.

Studies suggest that HPVs may play a role in cancers of the anus, vulva, vagina, and penis, and some cancers of the oropharynx.

Some types of HPVs are referred to as “low-risk” viruses because they rarely develop into cancer; these include HPV-6 and HPV-11. HPV viruses that can lead to the development of cancer are referred to as “high-risk.” Both high-risk and low-risk types of HPVs can cause the growth of abnormal cells, but generally only the high-risk types of HPVs may lead to cancer. Sexually transmitted, high-risk HPVs have been linked with cancer in both men and women; they include HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, and 69. These high-risk types of HPVs cause growths that are usually flat and nearly invisible, as compared with the warts caused by HPV-6 and HPV-11.

There are several compounds on the market for the topical treatment of venereal warts.

 

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Conditions that suggest HPV (Human Papilloma Virus)

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Counter Indicators

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HPV (Human Papilloma Virus) can lead to

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Recommendations for HPV (Human Papilloma Virus)

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Key

	Weak or unproven link
	Strong or generally accepted link
	Proven definite or direct link
	Very strongly or absolutely counter-indicative
	Likely to help
	Highly recommended

Glossary